Clinical Investigator - Eden Prairie, MN

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Company:
 		UnitedHealth Group
Company Profile | Current Opportunities (434)
Job Location(s): Eden Prairie
Employment Term: Regular
Employment TypeFull Time
Start Date:As soon as possible
Starting Salary Range:Not Provided
Required Experience: Open
Related Categories:Healthcare - Administration/Billing, Healthcare - Assistants/Aides/CNAs

Position Description

Job Description
Clinical Investigator - Eden Prairie, MN-313495
Description
Ingenix is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Ingenix.
We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.
As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.
Primary Responsibilities:
  • RN, LPN, or Certified coder with strong medical knowledge
  • Work with the provider resolution team and clinical investigations team to investigate, review, and research all types of post service claims with aberrant billing patterns, and may include claims related to post service utilization review
  • Clinical review of medical record and supporting documentation against submitted claims
  • Investigative management - collaborate with provider inquiry resolution team and provide clinical guidance
  • Adhere to state and federal compliance policies, reimbursement policies, and contract compliance
  • Identify treatment patterns and trends
  • Analyze clinical investigation and coding histories and provide written or verbal education to the provider
  • Consult with Medical Director and other clinical resources when necessary
  • Identify solutions to non-standard requests and problems
  • Solve moderately complex problems and/or conduct moderately complex analyses
  • Work with minimal guidance; seek guidance on only the most complex tasks
  • Translate concepts into practice
  • Provide explanations and information to health care professionals, billers, healthcare providers and others on difficult issues
  • Coach, provide feedback, and guide others
Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever.
Qualifications
Qualifications:
  • 2 + years experiences as an RN, LPN with a current, unrestricted license or Certified Coder is required
  • 2 + years of CPT/ICD-9 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines is required
  • Provider or claims Issue resolution experience a strong plus
  • Managed care experience is preferred, as is healthcare claims experience, and a background conducting clinical investigations
  • Secondary education is strongly preferred
  • Acts as a resource for others with less experience
  • Undergraduate degree or equivalent experience
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Claim Recovery/Resolution
Primary LocationUS-MN-Eden Prairie
Organization Pymt Acc - Fraud
Schedule Full-time
Number of Openings 1

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